SI Joint Dysfunction
What is SI joint dysfunktion?
Almost everyone suffers at least once in his life from back pain. The assumed cause is almost always a prolapsed disc. Meanwhile, we know that pain in the pelvic region can be a harmless dysfunction of the iliosacral joint (SI) with local muscle spasms in the adjacent lumbar spine and buttocks. Such pain can radiate into the groin, from the buttocks to the foot and simulate a prolapsed intervertebral disc. The SI dysfunction is one of the most therapy-resistant disorders of the body.
60-80% of the population suffers once in a lifetime from an SI dysfunction and thus of back pain.
Further transitional zones in which a dysfunction can frequently occur are the atlanto-occipital joints, the cervico-thoracic junction and the thoracolumbar junction.
Mechanism of the SI joint dysfunction
Frequently, complaints in the SI joint area are acute, whereby a weakening of the structures – usually compensated – can prevail for an extended period of time. For example, a predominantly seated activity may result in a shortening or over-stretching of certain muscles, which can lead to an imbalance in the whole body. Then it only requires an inappropriate movement or a high physical strain tocause sudden pain due to the dislocation and dysfunction of the SI-joint. The joint capsule is painfully irritated and the surrounding muscles harden. In addition, the muscles try to compensate the imbalance and the load shift, which leads to muscle contractions in the form of “trigger points”. The following muscles are most often affected:
-The lower parts of the spinal extensors und rotators
-The hip flexors (iliopsoas) and the quadratus lumborum
-The rectus and occasionally the oblique abdominal muscles
-Parts of the buttock muscles, such as the musculi glutaei and the piriformis muscle, and parts of the hip muscles.
Occasionally, the high tension of the contracted muscle bands cause nerve compression, such as the M. piriformis, on the sciatic nerve, which leads to severe pain and motion restriction comparable to lumbago. The affected ligaments can also substantially change their state of tension, thus leading to a further aggravation of the symptoms. As a result of the SI dysfunction, the entire lower back feels “unstable”, with unilateral muscle spasms. Due to the misalignment of the SI joint, the ilium bone also undergoes a positional change which can involve the hip joint as well. Since the human body is endeavoring to keep the normal spinal alignment due to reflective posture and position adaptations (muscle chain activity), higher corresponding parts of the vertebral column can be affected. This causes asymmetric loads on different parts of the spine in a zig-zag course from the bottom to the top when painful areas are found across the back muscles of the spine.
The symptoms which point to a dysfunction of the SI joint are manifold:
Diffuse “lower back pain”
Sharp pain directly in the SI joint. The pain can radiate into the legs, the lumbar region or the abdomen, which makes it difficult to distinguish between pain caused by intervertebral disc problems, vertebral problems or diseases of the abdomen.
Feeling of limping or cramping in the hip joint, possible restriction of the motion in the hip joint
Feeling of instability of the pelvis and the lower back
The pain can be triggered or intensified by bending far forward or backward and is usually alleviated by slightly tilting the pelvis towards the back
Remaining in one posture, long sitting, standing, lying, can be painful and lead to muscular stiffness which only improves slowly
Lying on the back with stretched legs is impossible
Pain can spread through the entire pelvic area, in particular in the ischial protuberances.
A further typical indication is the inguinal and symphysis pain, which is based on a mechanical overload of the symphysis ligaments. This may result in blood circulation disorders or a reflex dystrophy, for example a sudden coxarthrosis. Due to the change in the position of the pelvic bones and the increased tension of the muscles, blood vessels and nerves can also be compressed or irritated. For example, an SI joint dysfunction can alter the position of the sacrum bone in such a way that the organs that are innervated by the sacral parasympathetic nervous system (parts of the colon, the urinary bladder, male and female sexual organs) are affected by the irritated nerve roots.
The lower back is particularly stressed during pregnancy. Especially in the last third of the pregnancy the expectant mother’s back has to withstand a lot.
Lower back pain can also occur as an accompanying symptom in disorders of abdominal organs. The reflex hypertonus of the musculature of the lumbar and pelvic region can “dislocate” the SI joint.
Many causes can elicit SI joint pain:
Pelvic tilt: due to an oblique position of the pelvis, an imbalance occurs in the distribution of the trunk weight to the pelvic bones. As a result, one of the two pelvis sides is exposed to a greater load
Hyperlaxity of the supporting structures: Here, the supporting structures and supporting tissue is not strong enough to ensure sufficient resilience (connective tissue weakness)
Overstretching, e.g. by lifting excessive weights: an acute traumatic event. If the weights are too heavy, a single action is enough to push the joint out of his anatomical position.
Recurring non-physiological movements in everyday life: in contrast to the acute traumatic event, successive fatigue takes place, leading to increasing instability in the joint
Injury caused by a fall or another form of force action with a destabilizing effect on the SI joint
Stepping into a “void” or stumbling when SI joint is already unstable
Muscle spasms, a malposition or inflexibility in the cervical spine, temporomandipular joint, atlanto-occipital joint, other cranial bones or dura.
Muscular imbalance of the above-mentioned muscles
High muscular tone due to stress and insufficient relaxation
Rheumatic, degenerative joint diseases
Psychogenic stressors (anxiety, anger, stress, illness or other factors)
General pelvic symptoms due to sexual abuse or mental trauma
Various different treatment modalities are recommended for the therapy of SI joint pain. Intra-articular injections with or without corticoides, chiropractic manipulation, osteopathy, physical therapy, stabilizing exercises are the most common.
It is first of all necessary to take the inflammatory process in the pelvic skeleton and in the soft tissues into consideration before proceeding with the therapy.
The goal of the treatment in our medical practice is the restoration of the physiological stage of tension in the pelvic, hip, lumbar spine and abdominal musculature.
We consider the SI joint dysfunction to be more a muscular problem than a joint disorder.
The therapeutic approach consists of treating the active trigger points with dry needling (TDN). It is known that TDN is an effective therapy for the treatment of muscle tension and spasming.
An accurate evaluation of the symptoms based on the clinical findings shows excellent results in most of the patients.
Only a few sessions (4-6) are needed to achieve a significant reduction of pain and considerable improvement in the quality of life.
Additionally, muscle energy techniques and radial shockwave therapy may increase the therapeutic effect of dry needling acupuncture.